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Base de données d'évaluation

Evaluation report

PAK 1999/011: The Bond of Care: Mardan District 1998

Author: Massoud, N.; Shaukat, P.; Mahal, Z.; Andersson, N.; CIET International

Executive summary


The Government of NWFP, UNICEF, and UNDP are collaborating with CIET International - an international non governmental organisation devoted to building the community voice in planning - to introduce CIET methods (also referred as Sentinel Community Surveillance, SCS) in the province. The rationale for UNICEF is the Master Plan of Operation of the Government of Pakistan-UNICEF Country Programme of Cooperation 1996-1998. The overall objective of planning, monitoring, and evaluation, according to this Programme of Cooperation, is to stimulate dialogue on the situation of children and women. This dialogue should be based on evidence of trends and programme impact, ultimately leading to improved allocation and utilization of financial, human and organisational resources for children and women. UNDP joined the SCS project in May 1997 in the context of the institutional reform project in NWFP. One part of this project is devoted to building development management capacity in the districts of Mardan and Dera Ismail Khan.

Purpose / Objective

- To learn about the communities' perceptions and practices on care for women and children
- To identify actionable interventions for the care of the mother that can change the care for her child, ultimately leading to improved child survival, protection, and development
- To identify care resources at household and community levels (including time, energy, knowledge or money) that are necessary to bring about change in care practices
- To continue building provincial and district level capacities to conduct inquiries of this nature in the future

This survey makes use of new methodology, Sentinel Community Surveillance (or CIET method). The aim of the Community Voice in Planning Initiative is to strengthen capacities for community-based assessment and analysis at the provincial, district and community levels, while producing actionable data on priority problems rapidly and at low cost.


A survey of 1,708 households from 10 sites was carried out; 78% of the households were in rural areas. 26 health facilities were reviewed. A total of 1,443 women with children under three years were interviewed. Respondents reported on 1,674 children under three. Interviews were also conducted with 41 Traditional Birth Attendants and 15 Lady Health Visitors. Ten focus groups were held with mothers, ten focus groups with husbands, and ten focus groups with mothers-in-law.

Key Findings and Conclusions

About 43% of the children aged 6-36 months are chronically malnourished. A rural child is 45% more likely to be chronically malnourished than an urban child. Some 8.4% of children aged 6-36 months were reported to have low weight-for-height, this percentage being higher among boys than girls.

About 40% of household respondents reported that their children are not well grown for their age. There is an association between their perception and anthropometry; however, mothers tend to underestimate malnutrition, especially chronic malnutrition. Among children thought by their mothers to be well grown for their age, 35% were chronically malnourished and 5% were acutely malnourished.

Some 38% reported having taken iron/folate supplements during their last pregnancy, and 28.5% of those took the tablets for three months or more. Some 41% said they had less food during their pregnancy than before their pregnancy and 14% indicated not having enough food.

Asked how many antenatal check-ups they had during their last pregnancy, about 61% of women said they received no formal antenatal care. The average number of visits is higher in urban 2.07 than rural areas 1.3. Among the main reasons given for not going for check-ups are: local traditions 31%, lack of necessity 23%, non-existence of health problems 22% and financial constraints 16%.

A woman who received formal antenatal care is 3.6 times more likely to take iron/folate tablets and 39% more likely to report having had enough food during her last pregnancy. Among those who did receive formal antenatal care, 11% reported not having been satisfied at all and 38% were somewhat satisfied.

Focus groups with mothers were also asked whether men maltreated or even beat women in the area. In only one group, women said they were very well treated by their husbands. In three sites, women said they were badly treated by men. In three other communities, they thought there is a root cause of such maltreatment. As for beating, all groups indicated that beating of women is commonplace in Mardan District. In five groups, they were beaten without much regard; in the others, women termed such beating as the outcome of some reasons. Some said, however, that the practice is fast disappearing.

Breastfeeding is almost universal; only 0.6% of children were said not to have been breastfed at all. For 45% of children, breastfeeding started within the first day. Exclusive breastfeeding does not last long after birth, with liquid or solid complements given by 48% by the first month.


Suggested interventions:

Mother care
To take iron-folate tablets to the pregnant women
To avoid quarrels in the household
To provide adequate care to pregnant mothers

Child care
To give colostrum to the newborns
To initiate breastfeeding within the first two hours after birth

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Report information





ECD - Family & Community Practices

UNDP, Government of NWFP


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